The fellows stitch: Large caliber venous hemostasis in pediatric practice

Abstract

A subcutaneous figure of eight suture hemostasis strategy can provide a safe and efficient method for large caliber venous hemostasis in a pediatric practice with improved hemostasis times and no additional morbidity.

Femoral Venous Hemostasis in Children Using the Technique of “Figure-of-Eight” Sutures

“…This may require an extended period of pressure, which is stressful to children. According to previous literature, the average time of manual compression is 14 minutes (8–30 minutes) . In our center, the time of manual compression was 10–14 minutes.…”

A randomized comparison of modified subcutaneous “Z”‐stitch versus manual compression to achieve hemostasis after large caliber femoral venous sheath removal

“…Morgan et al and Zhou et al published a case series demonstrating feasibility and safety of the “Z”‐stitch in children after structural interventions using 6–22 F sheath . More recently, three other nonrandomized studies confirmed safety and efficacy of the method in patients undergoing catheter ablation of atrial fibrillation with the use of 15 F sheaths .…”

“…Both passages were done deeply under the skin to grasp as much of the underlying subcutaneous, adipose tissue as possible. Deep stitching was facilitated by modification of the original technique of subcutaneous “Z” or “figure‐of‐eight” suture where it was advised to pass the suture perpendicularly to the sheath . The modified technique introduced at our center (MD) uses longitudinal passage of the suture, which allows for deeper stitching while mitigating the risk of vessel injury.…”

“…Suture based dedicated devices have been tested as a method to achieve venous access site closure but are costly, imperfect and have not gained widespread acceptance so far . An alternative method of hemostasis, the subcutaneous “Z”‐stitch, has been introduced and is being increasingly adopted worldwide . However, it has not become a universal standard of care yet, and systematic data on its performance are very limited.…”

Venous hemostasis postcatheter ablation of atrial fibrillation while under therapeutic levels of oral and intravenous anticoagulation

“…Previous studies using venography and vascular ultrasound imaging modalities had demonstrated the safety and efficacy of the F-8 suture technique for femoral venous hemostasis [10][11][12][13][14][15]. This technique produces compression the femoral vein at the sheath entry point by the external soft tissue to achieve hemostasis, without causing thrombus, embolism, or venous stenosis.…”